There are a lot of different rules that dictate when kids can go to daycare or school when they are sick.

Kids don’t always have to stay home from daycare or school when they are sick.

The actual rules of your daycare or school are the ones that you are likely most familiar with, but there are also recommendations from the American Academy of Pediatrics and the CDC, in addition to state-specific regulations.

Can Your Sick Child Still Go to Daycare or School?

Most people know to stay home when they are sick.

“Stay home when you are sick. If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness. Avoid close contact with people who are sick.”

CDC on Information for Schools & Childcare Providers

But what exactly does it mean to be “sick” and how long are you supposed to stay home and avoid other people?

“Most minor illnesses do not constitute a reason for excluding a child from child care, unless the illness prevents the child from participating in normal activities, as determined by the child care staff, or the illness requires a need for care that is greater than staff can provide.”

Recommendations for Inclusion or Exclusion (Red Book)

In general, your child does not need to be kept home and out of daycare or school if they are able to participate in routine activities, do not need extra care, and have:

a cold (unless they have a fever) or other upper respiratory infection, even if they have a green or yellow runny nose

diarrhea that can be contained in a diaper or the child can make it to the bathroom without having an accident, as long as they aren’t having more than 2 stools above their usual or stools that contain blood or mucus

a rash without fever – most skin rashes won’t keep your kids out of school, like if they have poison ivy, hives, or even molluscum contagiosum and warts

Fifth disease – interestingly, you aren’t contagious once you have the characteristic Fifth disease rash

head lice – why not keep kids out of school if they have lice? It doesn’t stop them from spreading. They can get them treated at the end of the day.

pinworms – like lice, keeping kids out of school with pinworms isn’t going to stop them from spreading, although kids should be treated

pink eye – if caused by an infection, in general, should be able to stay or return if is improving, but keep in mind that most experts now think that kids with pink eye do not need to be excluded from daycare or school at all

oral lesions and are able to contain their drool (unless they have a fever), which would include hand foot mouth disease

skin lesions that can be covered, and if they can’t, then they can return after they have been on antibiotics for 24 hours (impetigo) or have started treatment (ringworm)

Why don’t you have to keep your kids home when they have RSV or many of these other common childhood diseases?

In addition to the fact that some kids would never get to go to daycare or school, since these diseases are so common, many kids continue to be contagious even after their symptoms have gone away. So excluding them doesn’t really keep the illnesses from spreading through the daycare or school.

So why not just send them when they have a fever or really don’t feel well?

In addition to the possibility that they might be a little more contagious at those times, it is because the typical daycare or school isn’t able to provide the one-on-one care that your child would likely need when feeling that sick, as your child probably isn’t going to want to participate in typical group activities.

Policies that are overly strict at excluding children from daycare and school may also lead to antibiotic overuse, as parents rush their kids to the doctor for and push for a quick cure because they need to go back to work.

Exclusion Criteria for Vaccine Preventable Diseases

While the exclusion criteria for many diseases simply extends to when your child is fever free, starts treatment, or feels well enough to return to daycare or school, for many now vaccine-preventable diseases, you will be excluded (quarantined) for much longer:

hepatitis A virus infection – exclusion for one week after illness starts

diphtheria – if survives having respiratory diphtheria, would likely be excluded until finishes treatment and has two negative cultures at least 24 hours apart

rotavirus – as with other diseases that causes diarrhea, children should be excluded until “stool frequency becomes no more than 2 stools above that child’s normal frequency” as diarrhea is contained in the child’s diaper or they aren’t having accidents

tetanus – if survives having tetanus, wouldn’t be excluded, as tetanus is not contagious

Unfortunately, kids are often contagious with many of these diseases, especially measles and chicken pox, even before they have obvious symptoms, which is why large outbreaks used to be so common.

Children will often be excluded from daycare or school if they are unvaccinated or not completely vaccinated and they are exposed to a vaccine-preventable disease.

But what if your child really does have a middle ear infection? Then he will get antibiotics, right?

Not necessarily.

Since most ear infections get better on their own, antibiotics are typically reserved for:

children under age 6 months with acute otitis media (typically ear pain and a bulging ear drum)

children who are at least 6 months with acute otitis media and severe signs or symptoms, including moderate or severe pain for at least 48 hours or a temperature of 102.2°F (39°C) or higher

children who are under 24 months with “double” ear infections – both ears are infected at the same time, even if they just have mild symptoms

For most other children, instead of having you start antibiotics right away, your pediatrician might have you wait for 48 hours – the observation option. You can then start the antibiotics if your child doesn’t get better after a period of watchful waiting for two or three days. Until then, an age-appropriate dose of Tylenol (acetaminophen) or Motrin (ibuprofen) can often help control pain or fever.

In addition to your pediatrician, a pediatric ENT specialist can be helpful if your child has persistent ear pain.

What to Know About Children with Earaches

While it is sometimes obvious to know what is going on when older kids complain of ear pain, it is important to understand that not every earache means an ear infection, and even when it does, it might not mean a prescription for an antibiotic.

being inconsolable or so irritable that your child does not even want to be held

having chest pain

is suddenly dizzy

being confused

having seizures

having severe vomiting

You should also seek medical attention if your child was getting better, but then got worse again, especially if they again develop a fever and a worsening cough. Or if your child has a chronic health problem, like asthma or diabetes, and the flu is making it hard to control.

How will your child be treated? It depends, on treatments might include oxygen, IV fluids, antiviral medications, and antibiotics (if there is a secondary bacterial infection), etc.

And remember that children under the age of two to five years and those with chronic health conditions, such as asthma, diabetes, neurologic and neuromuscular conditions, and heart disease, etc., are most at risk for severe flu complications.

In four of the last deadliest flu seasons, at least half of the kids had no underlying medical conditions.

But you don’t have to be at high risk to develop flu complications.

Many of the kids who die with the flu each year don’t have any underlying health problems.

And at least half of the kids who die with flu complications are school age children and teens.

Anyone, even previously healthy kids, can develop pneumonia, myocarditis, encephalitis, or septic shock, etc., so get help if you see any of the above signs and symptoms that your child with the flu is getting worse.

And get your kids vaccinated. Tragically, most kids who die with the flu each year didn’t have a flu shot.

What to Know About the Warning Signs of a Severe Case of the Flu

Seek medical attention if your child’s flu symptoms are getting worse, especially if it seemed they were getting better, but then got worse again, which can all be signs of complications of a severe flu case.

Not all diarrhea is caused by infections though. If the diarrhea lingers for more than a few weeks or keeps coming and going, then you might consider that your child might have a lactose intolerance, irritable bowel syndrome, Celiac disease, or other non-infectious cause.

Hints of Diarrhea Causes and Risk Factors

To help figure out what might be causing your child’s diarrhea, consider these questions and share the answers with your pediatrician:

Does your child have bloody diarrhea (sometimes a sign of a bacterial infection)?

Is your child getting dehydrated? While that doesn’t tell you want is causing the diarrhea, it is a good sign that you need to seek medical attention.

Does your younger child (under age 2 to 4 years) have bloody diarrhea that is becoming jelly-like and episodes of severe, colicky abdominal pain (sign of intussusception)?

Is your child in daycare? Has anyone else recently been sick with diarrhea or vomiting?

Has your child recently been on antibiotics (a risk for C. diff)?

Does your toddler with diarrhea drink a lot of juice (Toddler’s diarrhea)?

Have you recently traveled out of the country (Traveler’s diarrhea)? Did your child get sick a few days later (could be a bacterial or viral cause) or a few weeks later (parasites have longer incubation periods)?

Has your child recently spent time on a lake or river and possibly drank untreated water (risk for Giardia infection)?

Do you have any high risk pets, including turtles, snakes, lizards (or other reptiles); frogs, salamanders, newts (or other amphibians); chicks, chickens, ducklings, ducks, geese, and turkeys (or other poultry); mice, rats, hamsters, and guinea pigs (or other rodents); or farm animals (all can be a risk for Salmonella)?

Have you recently visited a farm or petting zoo (risk for Salmonella and E. coli)?

Has your child recently visited a water park or public swimming pool (risk for Cryptosporidium)?

Has your child recently eaten leftover food that had been unrefrigerated for more than two hours (risk for food poisoning)?

Is the diarrhea worse after your child drinks a lot of milk or eats a lot of dairy (a sign of lactose intolerance)?

Does your child have alternating episodes of constipation and diarrhea (irritable bowel syndrome)?

In addition to chronic diarrhea, is your child irritable, with poor weight gain and other symptoms (a sign of Celiac disease)?

Does your child also have abdominal pain or just diarrhea?

Is your child taking any medications that might cause diarrhea as a side effect?

Once you have narrowed down the possibilities, blood and stool tests, including stool culture tests for bacteria, parasites, and viruses can sometimes help to figure out what is causing your child’s diarrhea. Keep in mind that these are usually reserved for diarrhea symptoms that are severe (bloody diarrhea, fever, weight loss, etc.) or lingering for more than a few weeks.

And remember that the most common causes of diarrhea, including food poisoning and viral infections, typically go away on their own without treatment. In fact, you can make things worse if you treat some causes of diarrhea with antibiotics, including some Salmonella, Shigella, E. coli infections.

Still don’t know what is causing your child’s diarrhea? In addition to your pediatrician, a pediatric gastroenterologist can be helpful when your child has diarrhea.

What To Know About Diarrhea

While diarrhea is common in kids and we often don’t figure out the specific cause before it goes away on its own, there are clues that can help you figure out if your child’s diarrhea is caused by a virus, bacteria, parasite, or other condition.

There are many viruses that can cause a cold, which means that your kids can get a cold every few weeks or months, and year after year.

And unfortunately, there is no cure or vaccine to prevent your kids from getting these colds. That often leads parents to try and look for ways to help their kids feel better when they have a cold.

Cold Symptoms

Before trying to treat your child’s cold, you have to figure out when they have a cold.

Colds are often misdiagnosed as allergies, sinus infections, and even the flu.

That shouldn’t be too surprising when you look at the classic cold symptoms, which can include:

a runny nose – with clear, yellow, or green drainage (green doesn’t mean that it is a sinus infection!)

coughing – often from post-nasal drip

sore throat – often from post-nasal drip

sneezing

watery eyes

a low grade fever (usually under 102.2F or 39C) for the first few days

mild headaches

mild body aches

That’s right, you can have a fever with a cold!

Most importantly, understand that cold symptoms typically worsen over the first three to five days and then gradually get better over the next seven to ten days. So they can easily last for a good two weeks, although you can expect improvement in that second week.

Treating Cold Symptoms

Most cough and cold medicines should not be used in kids under age four to six years.

So how should you treat your child’s cold?

A pediatrician I once worked with when I was a student used to recommend “soup, suckers, and showers.”

However, since treating the symptoms won’t help the cold go away, you could do nothing at all. While that might seem harsh, keep in mind that colds go away on their own and most of the things that we do to treat cold symptoms don’t actually work all that well.

Still, if your child has a cold and doesn’t feel good, some soup and popsicles (suckers) couldn’t hurt. Nor could some time in the bathroom with the door closed and a hot shower going, so your child can breath in the steam (while being supervised).

What about cough and cold medicines?

Because of the risk of serious, sometimes life-threatening side effects, since 2007, cough and cold medicines have carried the warning “do not use in children under 4 years of age.” So anything you find over-the-counter for younger kids now is either homeopathic (diluted to nothing) or just has honey as its main ingredient.

Treating Hard To Control Cold Symptoms

What else can you do to help control your child’s cold symptoms?

You could try:

Letting him continue with his usual activities, including going to daycare or school, if he doesn’t have a fever and isn’t overly bothered by his cold symptoms.

Encouraging your child to drink extra fluids.

Using a cool mist humidifier.

Spraying a saline spray or nose drops into your child’s nose.

Suctioning your younger child’s nose with a bulb syringe after using saline nose drops. Keep in mind that even with specialty gadgets, like the NoseFrida, you can’t do deep suctioning like they do in the hospital, so any benefits will be very temporary. And this type of suctioning is for symptomatic relief, it won’t help your child get better any faster.

Encouraging your older child to blow his nose, although since this is mainly to help him feel better and won’t help him actually get better any faster, don’t nag him too much or cause a meltdown if he doesn’t want to do it.

Giving your child an age appropriate dose of acetaminophen or ibuprofen to reduce fever and/or any aches and pains.

While there are cold and cough medicines for older kids, over age four to six years, and nasal decongestant sprays (like Afrin and Neo-Synephrine) for kids over age six years, there isn’t a lot of evidence that they work. They definitely won’t help your child with a cold get better any faster, so make sure they are at least helping him feel better if you are using one of them.

Even the popular cold and cough medicines with guaifenesin to thin mucus or long-acting cough suppressants probably don’t do much or anything to help your kids feel better and certainly won’t help them get better faster.

What about prescription cough and cold medicines? Most were forced out of pharmacies by the FDA several years ago because they were never actually approved or evaluated to treat cough and cold symptoms. And the American Academy of Pediatrics has long been against the use of cough suppressants with narcotics, such as codeine.

Most importantly, do see your pediatrician if your infant under age three months has a fever (temp at or above 100.4F or 38C), if your older child continues to get worse after three to five days, or isn’t at least starting to get better after 10 days of having a cold.

And avoid asking your pediatrician for an antibiotic when your child just has a cold. Antibiotics don’t help colds get better faster.

What To Know About Treating Hard To Control Cold Symptoms

Perhaps the only thing more frustrating than having a cold, is having a child with a cold and feeling helpless that you can’t do more to control their cold symptoms.